By Mary Jane Stern
Recently through a social networking site, I connected with someone I went to school with. Unfortunately, she has gone out on disability because of diabetes and is covered under a Medicare Advantage Plan. She mentioned how she wasn’t too happy with Medicare and one big reason was the Medicare Therapeutic Shoe Program.
Medicare will only allow ONE pair of therapeutic shoes per calendar year. I went searching to find out why only ONE pair, but I wasn’t too successful. I guess it’s the law.
What is the Medicare Therapeutic Shoe Program?
Congress enacted the Medicare Therapeutic Shoe Bill to provide proper footwear and footwear inserts for people who have severe diabetic foot disease and qualify under Medicare Part B.
The program was designed as prevention against lower limb ulcers, amputations and other complications associated with diabetes.
Eligible patients qualify for ONE pair of shoes, plus an extra pair of inserts and/or shoe modifications for each calendar year.
The doctor who treats your diabetes must certify your need for therapeutic shoes or inserts. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
Are You Eligible for Therapeutic Shoes?
Quite a few people enrolled in Medicare don’t realize they are eligible for this program. You must be covered under Medicare Part B and all three of the following conditions are met
- You have diabetes
- You have one or more of the following conditions:
- Partial or complete foot amputation
- Past foot ulcers
- Calluses of either foot that could lead to ulcers
- Nerve damage in your feet with signs of calluses on either foot
- Deformity of either foot (for example, hammertoe or bunions)
- Poor circulation in either foot.
- Your doctor has certified your need in writing, and it states
- You meet the criteria for the shoes
What Type of Shoes will Medicare Cover?
The types of shoes that are covered each year include one of the following
- One pair of depth-inlay shoes
- Three pairs of inserts
- One pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes because of a foot deformity
- Two additional pairs of inserts
Note: In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.
Nothing Fancy or Deluxe!
Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe's therapeutic function - for example, a custom style, color or custom material.
Does the Co-payment Apply?
If you are enrolled in Original Medicare, under Medicare Part B you will be required to pay 20% of the approved Medicare amount.
If you are enrolled in a Medicare Advantage Health Plan, check with your plan. Some plans have a very small co-payment, but it really depends upon YOUR plan.
If you have a Medigap plan, the 20% will be paid after your annual deductible has been met.
When Can You Purchase the Shoes?
You are entitled to only ONE pair per year and if you originally purchased your shoes on July 4th, you are not entitled to purchase another pair until July 4th of the following year.
Therapeutic shoes can be very costly and I’m not sure if one pair of shoes per year would actually last. I think most of us purchase more than one pair of shoes per year. If you have an answer to either of these questions, let us know.
- Why will Medicare only pay for one pair of shoes per year if they have done this for prevention?
- How can you get Medicare to pay for an additional pair of therapeutic shoes?